島根県下の病棟看護職による退院調整の取り組み

The aim of this study was to clarify the approach and continuing nursing care of adjustment of leaving hospital by nursing of ward. The self-registering questionnaire were mailed to 228 nurse who bore the discharge adjustment of hospital in 61 hospitals of over 20 sickbeds. The survey content was the realities of the adjustment of hospital (cooperation at the person in charge and the adjustment time that related to presence and the conference of leaving hospital). The nurse head 92.5%, the sub-master nurse head 4.1%, and chief nurse 3.4% was adjustment of hospital. The patients for the discharge adjustment was necessary accounted for those who lived alone 29.2%, Long term care insurance user 26.4%,high medical treatment dependency patients 24.5%. The time of adjustment was instruction of doctor 27.9%, immediately after hospitalization 23.8%, nurse judgment 15.0%. The 84 person of nurse(57.1%) were prompting the use of the home-visit nursing. The nurse felt not cooperation to Public health nurse 85.7％, Outpatient nurse 59.2％, Person in charge of service 58.5%. It was recognized that the understanding of time and a social resource that was able to concentrate on the adjustment hospital was insufficient.
A systematic approach to outpatient care is required, with the requirement for an understanding of social resources, both within and outside the hospital, and daily, cooperation from the nursing staff in the care of patients when in transition between hospitals.

本研究の目的は，病棟看護職の退院調整の取り組みを明らかにし，継続看護に役立てることである。島根県下20床以上の61病院で退院調整をしている病棟看護職228人に，無記名自記式調査をした。質問内容は退院調整の実態（担当者，調整時期，退院調整カンファレンスの有無）と退院調整に関する連携の認識とした。退院調整は看護師長92.5％，副師長4.1％，主任3.4％が実施していた。退院調整の必要な患者は独居29.2％，介護保険利用者26.4％，医療依存の高い患者24.5％で，調整時期は主治医の指示27.9％，入院直後23.8％，看護師の判断15.0％だった。訪問看護の利用を84人（57.1％）がすすめていた。退院調整が不十分な連携先は行政保健師85.7％，外来看護師59.2％，サービス担当者58.5％であった。退院調整に専念できる時間や社会資源の理解も不十分と認識していた。病棟看護職が退院調整し連携をするには，社会資源の理解や病院内外と日常的に有機的連携がとれる組織的取り組みの必要性が示唆された。